New York City Department of Health and Mental Hygiene June 2016, No. 72

Table 1.

Table 1a.

Table 2.

Map 1.

Table 3.

Table 4.

Table 5.

Table 6.

Data Sources

Benzodiazepine prescriptions filled by New York City residents by drug type, age-adjusted rates per 1,000 residents, 2013–2014

NYC Office of the Chief Medical Examiner and NYC DOHMH Bureau of Vital Statistics 2000-2014: Mortality data were collected through an in-depth review of data and charts from the Health Department’s Bureau of Vital Statistics and the Office of the Chief Medical Examiner for 2000-2014. Rates calculated using NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2000-2014 updated October 2015. NYS Prescription Monitoring Program (PMP) 2013-2014, managed by the New York State Department of Health Bureau of Narcotics, includes data from drug dispensers on schedule II-V controlled substances.

To access the related Epi Data Brief, go to www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief72.pdf

Benzodiazepines in New York City

Data Tables

Any self-reported benzodiazepine misuse in the past year, New York City and United States, 2010-2013

Demographics of all unintentional benzodiazepine drug poisoning decedents, age-adjusted rates, New York City, 2011-2014

National Survey on Drug Use and Health (NSDUH) 2002-2013 conducted annually by Substance Abuse and Mental Health Services Administration [SAMHSA] includes a representative sample of NYC residents aged 12 years and older. Two-year averages are presented.

Top five New York City neighborhoods: Rates of unintentional benzodiazepine-involved poisoning (overdose) death by neighborhood, 2013-2014

Number and rate of benzodiazepine prescriptions filled by age, gender,and borough of residence, age-adjusted rates per 1,000 residents, New York City, 2013–2014

Demographics of New York City residents who filled a benzodiazepine prescription, age-adjusted rates per 1,000 residents, 2013–2014

Self-reported benzodiazepine misuse in the past year by age-group, New York City, 2002-2013

Demographics of New York City residents whowho concurrently filled at least one benzodiazepine prescription and at least one opioid analgesic prescription, age-adjusted rates per 1,000 residents, 2013–2014

Epi Data Tables

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene Page 2

N % N % N % N %

1,055,000 16.5 38,287,000 14.9 1,279,000 20.1 41,591,000 15.9

794,000 12.4 29,739,000 11.5 1,043,000 16.4 32,952,000 12.6

138,000 2.2 3,857,000 1.5 150,000 2.4 4,182,000 1.6

13,000 0.2 620,000 0.2 4,000 0.1 681,000 0.3

256,000 4 11,143,000 4.3 290,000 4.6 11,082,000 4.2

134,000 2.1 5,109,000 2 168,000 2.6 5,269,000 2

516,000 8 18,959,000 7.4 626,000 9.9 19,868,000 7.6

Benzodiazepines

Any Drug Except Marijuana

NYC 2010-2011 US 2011

Any Drug

Marijuana

Cocaine

Heroin

Source: National Survey on Drug Use and Health; analysis by Substance Abuse and Mental Health Services Administration [SAMHSA]NYC Data presented as two-year averages of 2010-2011 and 2012-2013National (US) data presented for the years 2011 and 2013

Table 1. Any self-reported drug use in the past year, New York City and US, 2010-2013

Opioid Analgesics

NYC 2012-2013 US 2013

Page 3

Table 1a. Self-reported benzoidazepine misuse in the past year by age group, New York City, 2002-2013

NYC data presented as two-year averages of 2002-2003, 2004-2005, 2006-2007, 2008-2009, 2010-2011, 2012-2013

Variable N % N % N % N % N % N %Benzodiazepines 100,000 1.6 80,000 1.3 143,000 2.3 90,000 1.4 134,000 2.1 168,000 2.6

12 to 17 8,000 1.3 3,000 0.6 3,000 0.6 2,000 0.3 6,000 1.2 2,000 0.418 to 25 26,000 2.9 11,000 1.4 37,000 4.1 45,000 4.8 34,000 3.6 42,000 4.026 to 34 26,000 2.2 45,000 4.4 23,000 2.2 24,000 1.9 26,000 2.2 68,000 5.635+ 40,000 1.2 21,000 0.5 80,000 2.3 20,000 0.5 68,000 1.8 56,000 1.5

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene

Source: National Survey on Drug Use and Health; analysis by by Substance Abuse and Mental Health Services Administration

2010-2011 2012-20132002-2003 2004-2005 2006-2007 2008-2009

Page 4

Table 2. Demographics of all unintentional Benzodiazepine drug poisoning decedents, age-adjusted rates, New York City, 2011-2014

Rates per 100,000 New Yorkers are age adjusted, except those for specific age groups.

Number Percent Rate Number Percent Rate Number Percent Rate Number Percent Rate

630 100% 9.4 730 100% 10.9 788 100% 11.6 800 100% 11.7

210 33% 3.1 278 38% 4.2 298 38% 4.4 301 38% 4.4Gender

Male 158 75% 5.0 207 74% 6.5 210 70% 6.5 202 67% 6.2Female 52 25% 1.5 71 26% 2.1 88 30% 2.4 99 33% 2.7

Race/Ethnicity†

Black (non-Hispanic/Latino) 24 12% 1.6 32 12% 2.0 24 8% 1.5 26 9% 1.6Hispanic 34 17% 1.8 63 23% 3.4 75 26% 4.0 65 23% 3.4White (non-Hispanic/Latino) 147 72% 6.7 178 65% 8.3 190 66% 8.8 196 68% 8.8

Age (years)15-24 16 8% 1.4 28 10% 2.5 23 8% 2.1 24 8% 2.225-34 53 25% 3.7 53 19% 3.6 57 19% 3.8 79 26% 5.235-44 47 22% 4.0 67 24% 5.7 66 22% 5.6 66 22% 5.645-54 64 30% 5.7 87 31% 7.8 92 31% 8.2 77 26% 6.955-84 30 14% 3.2 43 15% 4.8 60 20% 6.5 55 18% 5.8

Borough of Residence†

Bronx 30 16% 2.9 57 22% 5.4 43 17% 4.1 40 15% 3.5Brooklyn 47 25% 2.3 71 28% 3.6 57 22% 2.8 72 27% 3.6Manhattan 30 16% 2.2 38 15% 2.8 42 16% 3.1 48 18% 3.5Queens 41 22% 2.2 46 18% 2.4 76 29% 3.9 69 26% 3.7Staten Island 38 20% 10.3 42 17% 11.7 41 16% 11.5 37 14% 10.1

Borough of DeathBronx 35 17% 3.4 59 21% 5.6 56 19% 5.4 41 14% 3.7Brooklyn 56 27% 2.7 76 27% 3.9 68 23% 3.3 82 27% 4.0Manhattan 38 18% 2.9 53 19% 3.8 59 20% 4.3 67 22% 4.7Queens 43 20% 2.3 49 18% 2.6 77 26% 4.0 74 25% 3.9Staten Island 38 18% 10.3 41 15% 11.2 38 13% 10.6 37 12% 10.1

Neighborhood Poverty†*Low (wealthiest) 56 30% 4.0 72 28% 5.3 88 34% 6.5 72 27% 5.1Medium 69 37% 2.7 78 31% 3.1 72 28% 2.8 89 34% 3.5High 30 16% 1.9 51 20% 3.3 51 20% 3.1 53 20% 3.3Very High 31 17% 2.7 52 21% 4.6 47 18% 4.2 51 19% 4.3

Drug Type**Alcohol 74 35% 1.1 107 38% 1.6 117 39% 1.7 127 42% 1.8Cocaine 89 42% 1.3 113 41% 1.7 106 36% 1.6 93 31% 1.3Heroin 94 45% 1.4 153 55% 2.3 155 52% 2.3 187 62% 2.7Methadone 63 30% 0.9 106 38% 1.6 98 33% 1.5 70 23% 1.0Opioid Analgesics 113 54% 1.7 116 42% 1.7 133 45% 2.0 116 39% 1.7

Top 5 NYC Neighborhoods^Willowbrook 17.8 Fordham- Bronx Park 10.0South Beach- Tottenville 12.5 South Beach- Tottenville 9.9Stapleton- St. George 10.3 Northeast Bronx 8.3Rockaway 7.9 Hunts Point- Mott Haven 7.4Pelham-Throgs Neck 6.3 Pelham- Throgs Neck 7.4

†Percentage of deaths within subgroup are calculated among categories presented.

**Drug Type, not mutually exclusive.; percent will not equal 100%.

2011 2012 2013 2014

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene

*Neighborhood poverty (based on ZIP code) was defined as percent of residents with incomes below 100% of the federal poverty level (Census 2000), separated into four groups: low (<10%), medium (10%-<20%), high (20%-<30%) and very high (>=30%).

^Top five of 42 NYC Neighborhoods

Total Unintentional Drug Poisoning Deaths Involving Benzodiazepines

2011-2012 Rate 2013-2014 Rate

Source: Bureau of Vital Statistics/Office of the Chief Medical Examiner, New York City; Rates calculated using NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2000-2014 updated October 2015. Analysis by Health Department's Bureau of Alcohol and Drug Use Prevention, Care and Treatment.

Total Unintentional Drug Poisoning Deaths

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene Page 5

1Age adjusted rates are calculated using intercensal estimates updated December 2014, and are weighted to Census 2000.

*The United Hospital Fund (UHF) classifies New York City into 42 neighborhoods, comprised of contiguous ZIP codes.

Source: Bureau of Vital Statistics/Office of the Chief Medical Examiner, New York City; Rates calculated using NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2000-2014 updated October 2015. Analysis by Health Department's Bureau of Alcohol and Drug Use Prevention, Care and Treatment.

Map 1. Top five New York City Neighborhoods: Rates of unintentional benzodiazepine-involved poisoning (overdose) death by neighborhood, 2013-2014

Source: Office of Vital Statistics & Office of the Chief Medical Examiner, 2012-2013

Page 6

Source: New York State, Bureau of Narcotics Enforcement, Prescription Monitoring Program, 2013-2014

N % Rate of prescriptions filled per 1,000 NYC

residents2

N % Rate of prescriptions filled per 1,000 NYC

residents2

Total benzodiazepine prescriptions 1,712,155 100.0% 191 1,725,435 100.8% 191By drug type

Alprazolam 534,955 31.2% 59.7 535,227 31.3% 59.1Chlordiazepoxide Hydrochloride 7,530 0.4% 0.9 7,356 0.4% 0.8Clobazam 5,951 0.3% 0.7 7,635 0.4% 0.9Clonazepam 591,872 34.6% 66.3 610,941 35.7% 67.8Clorazepate Dipotassium 2,942 0.2% 0.3 2,625 0.2% 0.3Diazepam 190,790 11.1% 21.3 188,879 11.0% 20.9Estazolam 938 0.1% 0.1 800 0.0% 0.1Flurazepam Hydrochloride 4,535 0.3% 0.5 3,730 0.2% 0.4Lorazepam 317,492 18.5% 35.2 316,740 18.5% 34.7Midazolam Hydrochloride 209 0.0% 0.0 287 0.0% 0.0Oxazepam 1,420 0.1% 0.2 1,129 0.1% 0.1Quazepam 12 0.0% * 6 0.0% *Temazepam 44,688 2.6% 4.9 42,098 2.5% 4.6Triazolam 8,821 0.5% 1.0 7,982 0.5% 0.9

1Prescriptions written by veterinarians, or written under institutional licenses, or missing prescriber ID, or missing patient ID are excluded.

*Rates based on small numbers (RSE > 30) have been suppressed.

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene

20142013

2 Rates calculated using NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2000-2014 updated October 2015. Analysis by Health Department's Bureau of Alcohol and Drug Use Prevention, Care and Treatment.

Table 3. Benzodiazepine prescriptions1 filled by New York City residents by drug type, age-adjusted rates2 per 1,000 residents, 2013–2014

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene Page 7

Source: New York State, Bureau of Narcotics Enforcement, Prescription Monitoring Program, 2013-2014

Number Percent

Rate of prescriptions filled per 1,000 NYC

residents2 Number Percent

Rate of prescriptions filled

per 1,000 NYC residents2

Total number of benzodiazepine prescriptions 1,712,155 100% 191.2 1,725,435 100% 190.7

Median day supply 30 30Age3

0-14 9,288 1% 6.2 10,257 1% 6.815-24 57,111 3% 50.9 57,766 3% 52.525-34 214,091 13% 144.3 215,774 13% 143.335-44 249,326 15% 211.8 248,502 14% 210.345-54 358,799 21% 321.1 354,953 21% 317.755-64 377,709 22% 395.3 378,330 22% 389.565-84 368,488 22% 400.3 380,666 22% 404.085+ 77,241 5% 500.7 79,123 5% 505.0Missing 102 0% 64 0%

GenderMale 662,700 39% 161.8 672,561 39% 162.4Female 1,049,422 61% 215.1 1,052,793 61% 213.8Unknown 33 0% X 81 0% X

Borough of Residence4

Bronx 209,850 12% 149.9 218,375 13% 154.0Brooklyn 461,165 27% 173.3 461,445 27% 171.5Manhattan 495,994 29% 272.2 500,021 29% 272.7Queens 385,708 23% 151.4 389,958 23% 151.2Staten Island 159,438 9% 306.7 155,636 9% 296.2

1Prescriptions written by veterinarians, or written under institutional licenses, or missing prescriber ID, or missing patient ID are excluded.

3Patient age is an average of their age at all their prescriptions in the year.4Borough of residence is derived from the 3-digit zip code listed for patient zip on prescription. Most frequent borough of residence per patient is reported.

20142013

2 Rates calculated using NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2000-2014 updated October 2015. Analysis by Health Department's Bureau of Alcohol and Drug Use Prevention, Care and Treatment.

Table 4. Number and rates of benzodiazepine prescriptions1 filled by age, gender,and borough of residence, age-adjusted rates2 per 1,000 residents, New York City, 2013–2014

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene Page 8

Source: New York State, Bureau of Narcotics Enforcement, Prescription Monitoring Program, 2013-2014

Number PercentRate of persons who filled a benzodiazepine prescription per 1,000 NYC residents

Number Percent

Rate of persons who filled a benzodiazepine prescription per 1,000 NYC residents

Total number who filled a prescription 444,990 100% 49.9 440,918 100% 48.9Age group (years)3 0%

0-14 3,512 1% 2.3 3,784 1% 2.515-24 19,330 4% 17.2 19,223 4% 17.525-34 67,369 15% 45.4 66,806 15% 44.435-44 69,756 16% 59.3 68,632 16% 58.145-54 84,632 19% 75.8 82,846 19% 74.255-64 86,585 19% 90.6 85,525 19% 88.165-84 94,397 21% 102.6 94,852 22% 100.785+ 19,336 4% 125.4 19,211 4% 122.6Missing 73 0% X 39 0% XMean age (years) 51.8 51.8

Gender 0%Male 162,305 36% 39.8 162,472 37% 39.4Female 282,666 64% 58.4 278,398 63% 57.0Unknown 19 0% X 48 0% X

Borough of Residence4 0%Bronx 50,691 11% 36.3 51,290 12% 36.3Brooklyn 116,874 26% 43.9 115,516 26% 43.0Manhattan 139,613 31% 76.6 138,335 31% 75.5Queens 101,666 23% 40.3 101,044 23% 39.6Staten Island 36,146 8% 69.9 34,733 8% 66.4

Filled an opioid analgesic prescription in same year 123,966 28% 13.9 118,757 27% 13.1

1Prescriptions written by veterinarians, or written under institutional licenses, or missing prescriber ID, or missing patient ID are excluded.

3Patient age is an average of their age at all their prescriptions in the year.4Borough of residence is derived from the 3-digit zip code listed for patient zip on prescription. Most frequent borough of residence per patient is reported.

2013 2014

Table 5. Demographics of New York City residents who filled a benzodiazepine prescription,1 age-adjusted rates2 per 1,000 residents, 2013–2014

2Rates calculated using NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2000-2014 updated October 2015. Analysis by Health Department's Bureau of Alcohol and Drug Use Prevention, Care and Treatment.

Epi Data Tables, No. 72 New York City Department of Health and Mental Hygiene Page 9

Source: New York State, Bureau of Narcotics Enforcement, Prescription Monitoring Program, 2013-2014

Number Percent

Rate of persons who concurrently filled a benzodiazepine and opioid analgesic prescription per 1,000 NYC residents

Number Percent

Rate of persons who concurrently filled a benzodiazepine and opioid analgesic per 1,000 NYC residents

Filled a benzodiazpine and opioid analgesic prescription in same year 123,966 100% 13.9 118,757 100% 13.1

Age goup (years)3 0% 0%0-14 254 0% 0.2 251 0% 0.215-24 3,076 2% 2.7 2,800 2% 2.525-34 14,444 12% 9.7 13,275 11% 8.835-44 19,184 15% 16.3 17,808 15% 15.145-54 27,524 22% 24.6 26,109 22% 23.455-64 27,194 22% 28.5 26,182 22% 27.065-84 26,566 21% 28.9 26,422 22% 28.085+ 5,720 5% 37.1 5,905 5% 37.7Missing 4 0% X 5 0% XMean age (years) 53.8 0% 54.3 0%

GenderMale 47,111 38% 11.6 45,639 38% 11.1Female 76,850 62% 15.9 73,105 62% 14.9Unknown 5 0% X 13 0% X

Borough of Residence4 0% 0%Bronx 17,038 14% 12.2 16,666 14% 11.8Brooklyn 29,212 24% 11.0 27,746 23% 10.3Manhattan 37,685 30% 20.7 35,879 30% 19.6Queens 27,093 22% 10.6 26,255 22% 10.2Staten Island 12,938 10% 25.0 12,211 10% 23.2

1Prescriptions written by veterinarians, or written under institutional licenses, or missing prescriber ID, or missing patient ID are excluded.

3Patient age is an average of their age at all their prescriptions in the year.4Borough of residence is derived from the 3-digit zip code listed for patient zip on prescription. Most frequent borough of residence per patient is reported.

Table 6. Demographics of New York City residents who concurrently filled at least one benzodiazepine prescription and at least one opioid analgesic prescription,1 age-adjusted rates2 per 1,000 residents, 2013–2014

2013 2014

2Rates calculated using NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2000-2014 updated October 2015. Analysis by Health Department's Bureau of Alcohol and Drug Use Prevention, Care and Treatment.